04.03 Cardiac (Heart) Disease

Overview

  1. Pregnant patients with underlying cardiac disease may not be able to compensate appropriately for the increased blood volume / cardiac output

Nursing Points

General

  1. Concerning cardiac issues include, but are not limited to:
    1. Heart valve replacements (tissue and mechanical
    2. Marfan syndrome
    3. Cardiomyopathy
    4. Pulmonary HTN
    5. Congenital heart issue
    6. Heart failure

Assessment

  1. Baseline assessment of hemodynamics of both mom and fetus important
  2. Auscultate and note abnormal heart/lung sounds
    1. Murmurs are normal in pregnancy because of the extra blood volume
  3. Note any pain, discomfort with normal activity
  4. Cardiac monitoring may be indicated during labor

Therapeutic Management

  1. Manage as usual for the specific cardiac disease
  2. Administer diuretics to decrease preload if needed

Nursing Concepts

  1. Perfusion
  2. Fluid & Electrolytes

Patient Education

  1. Educate on appropriate weight gain
  2. Baseline obesity will place the client at even greater risk
  3. Healthy diet, low sodium

Reference Links

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Video Transcript

In this lesson I will explain cardiac disease in a pregnancy and your role in caring for this type of patient.

Let’s look at cardiac disease and why it is a problem in pregnancy. Pregnancy puts an increased workload on the heart because there is extra volume and then there is also increased weight that increases the work on the heart so this is even more of a problem for a patient that already has a not so good heart. Now let’s look at the heart. The heart is a pump and it is not able to pump effectively if there is cardiac disease. So the pump will be working harder in pregnancy to move the extra volume and get healthy blood flow through the placenta and to the fetus.

Some concerning cardiac issues can include heart valve replacements, marfan syndrome, cardiomyopathy, pulmonary HTN, congenital heart issue, and heart failure. Of course these are not all of them but a few examples that could lead to extra workload on the heart. Even women with no cardiac diseases can develop a problem in pregnancy because the heart can’t keep up with the extra weight and or volume.

For assessment we always need a baseline. So a baseline assessment of hemodynamics for mom and fetus is important. We need to auscultate heart and lung sounds. If there is any abnormality it needs to be noted. It is important to be aware that murmurs can be a normal finding in pregnancy because of the extra blood volume. If there is any pain or discomfort with normal activity it needs to be noted and reported.

For management we need to treat the disease, Whatever cardiac disease it is we need to manage with whatever is specific for the disease. If fluid overload is a piece of the problem we can give diuretics to decrease the preload. In this picture you can see how if there is an increase in preload, the blood coming into the heart, it is going to add increased work on the heart and if the heart is already diseased it will be even harder for the “pump” to pump.

Perfusion, oxygenation and fluid & electrolytes are the concepts. We need good perfusion to get to the blood and oxygen to the tissues and fetus. Fluid and electrolytes are important to manage and balance with cardiac disease.

For education we need to educate on appropriate weight gain. We do not want a cardiac patient to gain too much weight because this will add extra work to heart. If a patient is already overweight or obese this will put the patient at an even greater risk. A healthy diet should be instructed so the patient stays at a healthy weight and a diet low in sodium is important. Patients should also know signs to report such as a sudden increase in edema, shortness of breath, decreased fetal movement, and extreme tiredness.
Our key points to bring it all together are that in pregnancy there is an increased workload on the heart so the pump can get tired. The pump is also broken, it is not working at 100%. Pregnancy makes it even harder to manage the disease because of the pump being tired. Perfusion is the last key point. Not only do we need to perfuse the body as usual but also a placenta to get nutrients to the fetus. This is essential for healthy growth of the fetus. If our pump isn’t effective the perfusion to the body and placenta won’t be effective.

Make sure you check out the resources attached to this lesson and review different management of the various cardiac diseases. Now, go out and be your best selves today. And, as always, happy nursing.

Read more

  • Question 1 of 6

A nurse is caring for a pregnant, hypertensive client on bed rest. What nursing intervention is priority for the care of this client?

  • Question 2 of 6

A nurse is providing instructions to a pregnant client who also has a diagnosis of heart failure. What should be included in those instructions?

  • Question 3 of 6

A nurse is assessing a 30-week pregnant client. Which of the following findings should be reported to the provider?

  • Question 4 of 6

A nurse is caring for a pregnant client who is at 28 weeks’ gestation. Which of the following changes in cardiac output would the nurse expect to see in a client of this gestation?

  • Question 5 of 6

A nurse is educating a pregnant client on the impact of her high blood pressure during pregnancy. Which of the following is the most appropriate statement by the nurse?

  • Question 6 of 6

A nurse is providing education to a pregnant client with hypertension. What is the priority topic to include in this education?

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